The 'De-Skilling' Of Nursing

[TheCommuter]

What should be our greatest concern for the future of nursing?

We must fear the day if (or when) registered nurses (RNs) and licensed practical nurses (LPNs) will be less needed in healthcare due to systematic de-skilling of the nursing profession. Even though patients are becoming sicker and more complex in today's healthcare system, other professionals and paraprofessionals have started to perform tasks and assume roles that had once been within the strict realm of licensed nursing personnel.

The de-skilling of the nursing profession has been taking place for quite some time. For example, we have phlebotomists and phlebotomy technicians to draw blood in certain healthcare settings.

Medication aides regularly administer medications in many nursing homes, group homes, and assisted living facilities, even though the task of medication administration had once been a duty that was strictly performed by licensed nursing staff.

Some hospitals have policies that allow patient care assistants to insert and remove indwelling urinary catheters and discontinue peripheral IV catheters.

Some rehabilitation facilities and specialty hospitals have assembled wound care teams that consist of physical therapists and occupational therapists who perform all the dressing changes and handle all the complex wound care cases.

Many back office medical assistants now perform advanced skills in doctors' offices under the supervision of the physicians who employ them.

Pharmacy technicians now mix medications in hospitals on a regular basis, but RNs were once able to mix drugs in piggybacks for IV administration.

Rehab techs now ambulate patients post operatively when licensed nursing staff used to be the ones to ambulate 'early and often.'

More examples of de-skilling in the nursing profession exist. For instance, many healthcare facilities employ lay people to do the staffing and scheduling for nursing staff. These schedulers are given the fancy titles of 'staffing coordinator' or 'director of staffing,' and have been given responsibility for an administrative aspect that nursing management or supervisory staff strictly performed once upon a time. In addition, some emergency departments are considering hiring paramedics to lessen the need for ER nurses.

The writing is on the wall.

The nursing profession must stop surrendering our valuable skills to other healthcare workers now. Nurses need to fully embrace their skill sets and constantly be on the lookout for other disciplines who are attempting to remove yet another skill away from our roles. If even one unemployed nurse exists who needs a job, then de-skilling is a problem because non-nursing staff are displacing licensed nurses. If this systematic de-skilling does not stop anytime soon, the future of nursing might be in trouble.

[Asystole RN]

CNAs are not nurses. Yes, they are vital to providing patient care, but they do not possess a unique body of knowledge as nurses do.

Housekeeping feels overlooked. Maybe we should call them nurses, too. What the heck, just call everyone a nurse so no one gets their panties in a bunch.

This mentality is what comes from the "Everybody is a winner and gets a trophy" thinking.

Now you get it.

[Asystole RN]

Pretty soon we will have licensed healthcare associates. All specialized in one area only so they have few career options.

Many RNs do specialize in one area.

[tothepointeLVN, LVN]

Yes but these won't be nurses just glorified techs. My friend in NZ is a Cardiac Physiologist which is a really really really fancy way of saying she assists with cath labs and stress tests but that and that only. (She has a science degree but I'm not sure if that was a requirement)

So I see that happening at both ends nurses will hyperspecialize and so will the UAP's as more and more become expected of them.

We can reasonably expect as much change in the future as we've had in the past.

[Asystole RN]

Yes but these won't be nurses just glorified techs. My friend in NZ is a Cardiac Physiologist which is a really really really fancy way of saying she assists with cath labs and stress tests but that and that only. (She has a science degree but I'm not sure if that was a requirement)

So I see that happening at both ends nurses will hyperspecialize and so will the UAP's as more and more become expected of them.

We can reasonably expect as much change in the future as we've had in the past.

Things will change but nursing is not going anywhere, at least not registered nursing. I do think that registered nursing will become more and more specialized similar to the physician model. There will be general practice nurses and specialists.

[tothepointeLVN, LVN]

Nursing as a concept is very old but licensing of nursing as a title only came about in the last 100 years or so. People always think the position they are in now will be the one to remain but we may find a different story when we are the ones in our nursing home beds which have been relocated to the moon for cost cutting efficiency and "nursing" has been outsourced to the illegal aliens

[tnmarie]

This has been a most interesting read. I hope everyone is as passionate about pt care as they are about their precious titles and degrees.

To be honest, I naively thought that BSNs were strictly management. I suppose in hospitals where the are phasing out ASNs this won't be the case. To be fair, when I worked with RNs they were ALL BSNs (and oh yeah, officers). They gave meds and charted and we did everything else from wiping butt, VS, starting IVs, foleys, and dropping NG tubes. We were a hybrid of CNA and LPN but with the fancy title of Aerospace Medical Technician (I never called myself a nurse because I was not one at the time).

I think phasing out ASNs is a mistake. That way nurses who don't want to wipe butt or touch a patient can become BSNs (and sit in their cushy offices ) and those of us who became nurses to actually touch and physically nurse people can do so and you won't have nurses on the floor afraid or too proud to wipe a butt.

When my mom became a nurse 25 years ago, RNs were managers and LPNs did patient care. That is why she was never interested in becoming an RN (and she could nurse circles around many, many RNs, btw). I had to become an LPN to do the kind of patient care I did in the military in the civilian world. They seem to be phasing out LPNs here, so I am getting my ASN so I can continue to do what I'm doing now. I am not interested in my BSN because classes on management and a bunch more prereqs do not interest me and will do little to improve my patient care, IMO. Though if that is what I have to do to continue to do actual pt care, I will.

Some nurses are good at management and don't want anything to do with hands on pt care. Some nurses want to be in the trenches. I think it is important to have BSNs and ASNs to differentiate the two. I also think we should all recognize that both have their place in nursing care and stop ******* bickering about it. Of course I have no idea where this will leave the LPN. I guess doing LTC, home health, private duty and other jobs where you need a nurse but no one wants to pay an RN salary to have one...

[TheCommuter, BSN, RN]

To be honest, I naively thought that BSNs were strictly management.

I've seen multiple RNs with BSN degrees who push medication carts and work as floor nurses at nursing homes and rehab facilities. On the other hand, I've seen LPNs in administrative positions such as assistant director of nursing, director of wellness, unit manager, and so forth. I've also seen a fair share of RNs with associate degrees in nursing management positions. Heck, I even work with an RN with a MSN degree who works as a floor nurse.

Personality type plays a heavier role than educational attainment in whether the nurse desires to ascend to a managerial role. Even though a nurse might have an RN license and a BSN or MSN degree, higher education does not inculcate natural leadership qualities.

[BrandonLPN, LPN]

I think the BSN program makes that nurse better at "managing" in the sense of managing care by delegating tasks to others. I always thought this was the intended role of the BSN within the team framework. I'm not sure that it actually makes the BSN better at performing the tasks themselves, more better at seeing the bigger picture and coordinating care. Management in an administrative sense is totally different, and doesn't have much to do with a nurse's level of licensure.

[OCNRN63, RN]

Now you get it.

I never "didn't" get it.

[Asystole RN]

This has been a most interesting read. I hope everyone is as passionate about pt care as they are about their precious titles and degrees.

To be honest, I naively thought that BSNs were strictly management. I suppose in hospitals where the are phasing out ASNs this won't be the case. To be fair, when I worked with RNs they were ALL BSNs (and oh yeah, officers). They gave meds and charted and we did everything else from wiping butt, VS, starting IVs, foleys, and dropping NG tubes. We were a hybrid of CNA and LPN but with the fancy title of Aerospace Medical Technician (I never called myself a nurse because I was not one at the time).

I think phasing out ASNs is a mistake. That way nurses who don't want to wipe butt or touch a patient can become BSNs (and sit in their cushy offices ) and those of us who became nurses to actually touch and physically nurse people can do so and you won't have nurses on the floor afraid or too proud to wipe a butt.

When my mom became a nurse 25 years ago, RNs were managers and LPNs did patient care. That is why she was never interested in becoming an RN (and she could nurse circles around many, many RNs, btw). I had to become an LPN to do the kind of patient care I did in the military in the civilian world. They seem to be phasing out LPNs here, so I am getting my ASN so I can continue to do what I'm doing now. I am not interested in my BSN because classes on management and a bunch more prereqs do not interest me and will do little to improve my patient care, IMO. Though if that is what I have to do to continue to do actual pt care, I will.

Some nurses are good at management and don't want anything to do with hands on pt care. Some nurses want to be in the trenches. I think it is important to have BSNs and ASNs to differentiate the two. I also think we should all recognize that both have their place in nursing care and stop ******* bickering about it. Of course I have no idea where this will leave the LPN. I guess doing LTC, home health, private duty and other jobs where you need a nurse but no one wants to pay an RN salary to have one...

The BSN nurse predates all other forms of nursing except the Diploma nurse. Many hospitals are actively attempting to increase the ratio of BSN nurses on the floor.

The level of academic achievement of a nurse however has nothing to do with their clinical practice however.

[Asystole RN]

I never "didn't" get it.

My original statement was facetious, now you get it?

[BrandonLPN, LPN]

The level of academic achievement of a nurse however has nothing to do with their clinical practice however.

I don't understand what you mean by this. Education should determine how a nurse can practice. Since a BSN nurse has more schooling, he should have a wider scope of practice and probably it's own licensure. With an enhanced license of its own, the BSN nurse would be in a better position to demand more money. Without something like this it just seems like education for the sake of education. Why have extra training if it doesn't result in more privileges and money?